Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity. The medical treatment involves the administration of uterotonic agents, in some cases the use of intrauterine balloon catheter and the implementation of medical measures to prevent secondary atony (uterine fundal massage, bladder outlet…) [1].

Synopsis

Total Uterine Ligation for the conservative management of surgical postpartum hemorrhage may reduce the risk of synechia in comparison to compression penetrating sutures associated to Total Uterine Ligation.

In case of a non-satisfactory hemostasis, the conservative treatment requires uterine artery embolization or surgical techniques to avoid hysterectomy [2]. Uterine artery embolization is a highly effective treatment that cannot be performed in hemodynamically unstable patients with uncontrolled bleeding [1]. Pregnancies after uterine artery embolization have been reported, but the technique involves risks of synechia and/or uterine necrosis that can lead to infertility or secondary hysterectomy [3,4]. Surgical techniques are based on vascular ligation or uterine compression [1]. The principal techniques of uterine compression are associated with a high risk of complications such as necrosis, infections and especially uterine synechia that occurs in up to 54% of cases [5,6]. Most authors have assumed that these complications and especially the synechia are promoted by the presence of compression penetrating sutures (CPS) breaking the integrity of the uterine cavity [6].

Total uterine ligation (TUL) has been described 10 years ago by Huissoud et al. [7]. It involves simultaneous compressions of the uterus and its principal afferent arteries by circular compressive non-penetrating sutures. The principal merit of TUL is the respect of the integrity of the uterine cavity [7].

The aim of the study was to evaluate the prevalence of uterine synechia after total uterine ligation (TUL) in comparison to TUL associated with compression penetrating sutures (CPS) in the conservative surgical management of severe postpartum hemorrhage.